A 44 year old female presented with fever, dysphagia, hiccups and weight loss for 3 months

A 44 year old female presented with low grade fever, dysphagia, hiccups and weight loss for 3 months. On examination BP was 100/60, regular pulse 100bpm, muffled heart sounds with pericardial friction rub. ECG was of low voltage and chest X-ray showed enlarged cardiac shadow. ESR was 70mm/hour. PPD 9mm. Echocardiogram revealed large pericardial effusion

a) What is diagnosis?

b) How would you treat pericardial effusion if it is recurrent?

c) What are the treatment options available?

d) Are steroids indicated?

Answers:

a.      Tuberculous pericardial Effusion
b.      Pericardiocentesis, pericardial window pericardiotomy
c.       Triple therapy INH/Rifampicin/Ethambutol for 9 months
d.      Constrictive tuberculous pericarditis steroids are given, but in HIV with Tuberculous pericarditis without constriction , steroids should not be given.

Reference:

Chapter 40, page 667 – Pericardial disease- Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC
Reuter H, Burgess LJ, Louw VJ, Doubell AF. Experience with adjunctive corticosteroids in managing tuberculous pericarditis. Cardiovasc J S Afr 2006;17:233-238 [Medline]

Comments

STEMI ECG Criteria and Universal Definition of MI

STEMI ECG Criteria and the Universal Definition of Myocardial Infarction: A Complete Guide for Clinicians Early and accurate diagnosis of acute myocardial infarction (AMI) remains the cornerstone of reducing morbidity and mortality in patients presenting with chest pain. Among all forms of acute coronary syndromes (ACS), ST-elevation myocardial infarction (STEMI) represents the most time-sensitive emergency, requiring immediate reperfusion therapy. This article provides a clinically relevant summary of the STEMI ECG criteria and the Universal Definition of Myocardial Infarction (UDMI), based on the latest consensus guidelines from the ESC, ACC, AHA, and WHF. --- 1. Understanding STEMI: Why Accurate ECG Interpretation Matters A 12-lead ECG remains the first and most critical diagnostic test when evaluating suspected myocardial infarction. STEMI is identified when there is evidence of acute coronary artery occlusion, producing transmural ischemia and characteristic ST-segment eleva...

2025 AHA/ACC Hypertension Guidelines Key points

2025 AHA/ACC Hypertension Guidelines Explained: A Clear Summary for Clinicians and Students Hypertension remains one of the most significant contributors to cardiovascular morbidity and mortality worldwide. With continual refinement of evidence and risk-based strategies, the 2025 AHA/ACC Hypertension Guidelines bring an updated, practical approach that clinicians can use in daily practice. To make learning easier, I’ve created a clean and modern infographic summarizing all major recommendations. You can download it below and use it for study, teaching, or clinical reference. Download Infographic (PNG): 2025 Hypertension Guideline Infographic This post breaks down the key points from the guidelines and complements the infographic for a complete understanding. --- BP Categories: Understanding the Updated Thresholds The guidelines maintain the well-established classification of blood pressure: Normal: <120 / <80 Elevated: 120–129 / <80 Stage 1 Hypertension: 130–139 and/or 8...

Learn Echocardiography | Standard Protocol for Performing Comprehensive Echocardiogram | Explained with Images and Videos

If you are just starting to learn echocardiography, you will find that learning the full echo examination protocol will be immensely useful. The full protocol will provide a solid foundation for your career in echo. I personally found that once I could execute the standard protocol flawlessly, I was able to add and refine additional echo scanning skills while deepening my understanding of the purpose of each echo image. The echo protocol illustrated in this article is the same one we currently use for all our patients in the hospital and meets or exceeds the standards of American Society of Echocardiography (ASE) for an adult echocardiography examination. The protocol presented here is meant as a guideline and does not cover every aspect (such as off axis views) of an echo examination. Also other hospitals will probably have slight variations of this protocol depending on the lab's needs, which is normal. This article's main purpose is to provide a solid foundation for ...

Dr. Usman's Cardiology Notes

Search This Blog